welcome!

1. welcome! Cultural Competency - Key Considerations and Awareness for an Inclusive VA Workforce John Fuller, Ed.D. Chief Diversity Educator Office of Diversity and Inclusion

2. Learning Objectives At the end of this session, you will have gained knowledge of key considerations for workforce inclusion through Examining: How external and internal factors affect you and your employees Identifying: Perceptions of Diversity, Inclusion, and Culture Recognizing: Cultural Competency is a lifelong process Discussing: Various cultural awareness areas to include: Generational, Religious and Veteran cultures Considering : Cultural competency’s relation to Patient Centered Care and awareness of Employee Self-Determination Theory

3. To fulfill the mission and vision • A Diverse Workforce: Build a diverse, high-performing workforce that reflects all segments of society. • An Inclusive Workplace: Cultivate a flexible, collaborative, and inclusive work environment that leverages cultural competency and empowers all contributors. • Outstanding Public Service: Facilitate outstanding, culturally competent public service and stakeholder relations through effective leadership and accountability. DI Strategic Plan

4. Equality of Employees Everyone has the ability to do something amazing; some just do it on a more regular basis.

5. Managers’ and Employees’ Workplace Challenges Co-Responsibility

6. Our Customer is Changing • There will be more Veterans who: • Live in Rural Areas • Identify as LGBT • Have service-connected disabilities • Are Hispanic/Women • Hold diverse religious beliefs • Are from younger generations All Expect Inclusive Services

7. From Road Rage to Desk Rage • Commuting to work and someone cuts you off, accident or weather delays, etc.? • Just received a foreclosure notice on your home? • Husband, wife, or partner lost their job yesterday? • Listening to constant criticisms of the VA in the media? • Not being allowed to telework if eligible? • Thinking about your current boss? or co-workers?... Your tremendous workload?....then you arrive at work!

8. Personal Problems 62% Job overload 60% Financial Stress 56% Lack of Resources 47% Depression/Anxiety 46% Issues with co-workers 41% Technology Issues 31% Care giving Responsibilities 30% Issues with supervisors 26% Lack of training 23% Presenteeism “I just want to do my 8 hours and go home. Help me make it through the day!” http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/EmployeeWellBeing.aspx

9. Non-productive Harassing or Incivil Workplace Behaviors • Missing work, taking extended breaks, finishing projects late • Accepting favors, like missing work without penalty • Racial, ethnic, or sexual comments/slurs • Engaging in provocative conduct • Gossiping about anything • Using excessive profanity within your communications

10. The Incivility Continuum • Negative Behavior • Rude comments (hey, nothing personal!) • Insensitive actions • Unintentional slights • Complaining • Gossip/rumors • Cultural bias • Crude jokes • Profanity • Rolling eyes • Verbal Aggression • Yelling / loud voice • Belittling comments • Intimidation / threats • Discriminatory comments • Cursing at someone • Humiliation • Physical/Sexual Aggression • Assault / Battery • Throwing objects • Violent outbursts (e.g., hitting the wall) • Inappropriate touching • Harassment

11. Humor - A Risky Behavior? • Humor can relieve tension and energize • teasing and sarcasm, however, are high risk communications. • Does this mean that all fun is out of order in the workplace? • "It was just a joke" is not an excuse. • People often have such different perspectives on sarcasm, jokes, etc. • Remember that only the impact, and not the intent • Make certain that your behavior; whether in person, by phone, text, twitter, Facebook, or via email, is welcome.

12. What Can You Do? • Say you do not like it and ask the person to stop. • Tell your supervisor • If you are a supervisor and witness this, stop the behavior immediately. • If the conduct is repeated it can become a violation and the offender can be advised of this. • Inform employee to keep a log or diary of the conduct, including dates, times, witnesses, direct quotes, emails, tweets, Facebook postings, and any documents or photographs.

13. Psychological Safety Is it safe to take a risk? The right to express thoughts and opinions freely and encourage open expression within a climate of civility, sensitivity and mutual respect. Are co-workers comfortable and capable of having a discussion with issues, i.e., Immigration, Religion, LGBT, Political Elections, Affirmative Action, in-house promotions, Tea Party, Unions, changes in the workplace, etc., openly and respectfully? Veterans WILL talk about these subjects!

14. When was the last time you received recognition at work for a job well done or gave recognition to someone else for a job well done? • Does not have to be supervisor to subordinate • Encourage encouragement and set the example .

15. Rapid Demographic Changes1990-2010 • Only one-third of households now have children • Since 1990 more Asians were added (4.3 million) to the population than Blacks (3.7 million) • About 430,000 Asians arrived in the U.S. in 2010 representing 36% of all new immigrants that year. • Almost one in six Americans are Hispanic (31% of immigrants) • More than doubled since 1990

16. Rapid Demographic Changes • 11 Million people in 2012 on Social Security Disability Insurance compared to 4.2 Million in 1990 • Educational Gap is growing • Women make up nearly 60% of college enrollment • More women receive graduate and doctorate degrees • 5.5 Million 85+ years of age in population • Doubled since 1990 • 41% share of births by unmarried women in 2010 • (up from 26% in 1990)

17. It is not Quantum Physics but…What is Diversity…..really? In its broadest context, diversity includes all that makes us unique: race, color, gender, religion, national origin, age, disability, culture, sexual orientation, gender identity, parental status, educational background, socioeconomic status, intellectual perspective, organizational level, and more. You It is I! From ODI’s Glossary of Terms http://www.diversity.va.gov/tools/glossary.aspx Nine Dimensions of Difference Reprinted with permission from Loden Associates.

18. Secondary Dimensions • Characteristics that represent an individual’s group identity • Unlike primary dimensions because of the element of choice Reprinted with permission from Loden Associates.

19. What’s Inclusion An Inclusive Workplace allows leaders to leverage the diverse talents and attributes of the entire workforce. • Inclusion: A practice that enables the full participation and contribution of the workforce in support of the mission of the organization by eliminating implicit and explicit barriers. Empowering the full potential of all employees.

20. What is Culture? Integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.

21. Cultural Competence Cultural Competence refers to a combination of knowledge, skills and awareness pertaining to cultural differences and different interpretations across groups It includes the awareness of and respect for differences, without making assumptions that everyone from a particular background holds the same beliefs and practices.

22. Joint Commission Expectations *Cultural competence requires organizations and their personnel to do the following: • (1) value diversity; • (2) assess themselves; • (3) manage the dynamics of difference; • (4) acquire and institutionalize cultural knowledge; and • (5) adapt to diversity and the cultural contexts of individuals and communities served *The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.

23. How Does Your Level of Cultural Competency Affect Veteran Care? • Health care providers bring perception, traditions, and patters of communications based on cultural, racial and ethnic identity to the clinician-patient interaction. • Cultural issues can influence appropriate diagnosis, treatment adherence as well as care seeking behavior and maintenance by Veterans leading to health care disparities.

24. VHA Defining Excellence • Patient (Veteran) centered; • Characterized by team care; • Continuously improving itself; and • Data driven, evidence based

25. Data Driven & Evidence Based 10 Principles • Service quality and value are always defined by the Veteran; • Veteran participation adds value and quality to their service experience; • Everyone must believe that the Veteran matters and act that way (Veteran-focused culture); • Find, hire, train and retain competent and caring employees;

26. 10 Principles, cont. • Veterans expect employees who are not only well trained but have good interpersonal skills; • Veterans expect the service experience to be seamless; • Avoid making Veterans wait for the service; • Create the setting (environment) the Veteran expects; • Measure all aspects of the service experience - ‘what gets measured gets managed’ - Ask Veterans about their experience at the time the service is being delivered; and • Commit to continuous quality improvement, i.e., patient satisfaction surveys, town hall meetings, etc.

28. Service Core Values Echo Throughout the VA • Army: Loyalty, Duty, Respect, Selfless Service, Honor, Integrity, Personal Courage • Navy and Marine Corps: Honor, Courage, Commitment • Air Force: Integrity, Service Before Self, Excellence • Coast Guard: Honor, Respect, Devotion to Duty (Advocacy) VA War Related Illness and Injury Study Center (WRIISC) )2011

29. Integrity Commitment Advocacy Respect Excellence Defines Who We Are

30. Military vs. Civilian Work Culture • Military: Command & Control Operations Model • Hierarchical /vertical structure - more exact rules of conduct • Veterans share a bond in beliefs, traditions, values, and the concept of rank and structure – Not just a job but a way of life • Firm, fair and consistent plus always a sense of urgency in getting the mission accomplished • Far less time spent in meetings – • The B vs. L&M Principle

31. Civilian vs. Military Work Culture • Corporate/Non-military: • Collaborative Model • More implied or "understood" rules of conduct • Flexible/ambiguous roles & status - variations across teams • Less defined career progression or lateral assignment opportunity No matter the length of service or era, all Veterans still have much of their military culture ingrained in them. However, separating active duty members and current Veterans of the VA need to be able to adjust and collaborate.

32. Language Awareness for CiviliansMilitary Cultural Competence • AIT • Tunnel Rat • FUBAR • O Dark 30 • Head • MOS • ADA • In Country • DEROS • Butter Bar • Green Zone • IED If you don’t know, it’s okay to ask (or to Google!)

33. Average age of soldiers World War II – 26 Volunteers and Draft

34. Average age of soldiers Vietnam – 19 Draft and Volunteers

35. Average age of soldiers Iraq/Afghanistan 30 All Vounteer

37. Some Guidelines – Interacting with Veterans • It is never OK to ask a Veteran if he or she has killed someone in combat or joke about it. • When you thank a Veteran for their service it is appreciated. • Don’t tell us that wars are a waste of dollars or lives or was fought for oil – • What we may hear in that is that our best friend or other brothers and sisters in arms died for nothing. • Many more of us today have PTSD or TBI. • We can be sensitive about our acquired disability and that war injuries today are different and often not visible. • It is not OK to tell someone they “don’t look disabled”

38. Cultural Implications for Female Veterans Over 1.8 Million Female Veterans 300,000 Female VA Patients

39. Women Veterans • Struggling to find work – Can be choice or circumstance, i.e., family, school, disability preventing full time work. • nearly one out of five women who served in the military at home or abroad during the two wars is now without a job, according to the new Bureau of Labor Statistics report • More than 40% of women Veterans surveyed were very dissatisfied with the competence level of the VA for women-specific or gender-specific issues • Women have had difficulty gaining recognition for their combat service.

40. Women Veterans • VA and DoD finds assaults more common – study shows more happen in war zones and becoming more frequent in all locations. • Nearly 50% of women sent to Iraq and Afghanistan report being sexually harassed. • 42% experience PTSD as a result Himmelfarb, N., Yaeger, D., & Mintz, J. Posttraumatic stress disorder in female veterans with military and civilian sexual trauma. Journal of Traumatic Stress, 19, 837-846.

41. Religious/Spiritual Beliefs and Practices

42. Religion & Culture – Americans who say they are……. 68% are either Moderately or Very Religious 32 % are either not religious or Non Affiliated

43. How Many Symbols Can You Identify?

44. Asian American Religious Beliefs* • Christian 42% • Unaffiliated 26% • Buddhist 14% • Hindu 10% • Muslim 4% • Other Religion 2% • Sikh 1% *www.pewsocialtrends.org/2012/6/1/the-rise-of-asian-americans * Pew Forum on Religion & Public Life “While the U.S. is generally considered a highly religious nation, African-Americans are markedly more religious on a variety of measures than the U.S. population as a whole, including level of affiliation with a religion, attendance at religious services, frequency of prayer and religion’s importance in life (79%)…..nearly 80% Protestant.”**

45. Generational Perspectives • Whatever your age, the other ages you have are still inside of you. • That’s what gives you the compassion and patience for those who are irritatingly younger (or older) than you! • The principles other generations used to get through life remain relevant – yet you may need a completely different set of tools in order to tackle modern nuances of the current workplace.

46. What is a Generation? • “In addition to coincidence of birth year grouping, a generation is also defined by common tastes, attitudes, and experience…. • Those times encompass a myriad of circumstances – economic, social, sociological, and, of course, demographic.” Zemke, R. Raines, C., & Filipczak, B. (2010) Generations at work: Managing the clash of Veterans, Boomers, Xers, and Nexters in your workplace. New York:Amacon.

47. Generational Differences • Preferred Leadership Approach • Communication Style • Motivational Buttons • How They Interact with Others • Preferred Approach to Feedback • View toward the VA When generations fail to communicate with each other: • May impact turnover rates, recruitment, hiring, training, retention) • May impact grievances and complaints • May impact perceptions of fairness & equity

48. Department of Veterans Affairs by Generations Source: ODI Workforce Analysis Team, May 2011 April 2011

49. Department of Veterans Affairs by Generations Source: ODI Workforce Analysis Team *2 SES Millennial

50. Current Working Generations • Veterans or Traditionalists (1900-1945) • Baby Boomers (1946-1964) • Generation X (1965-1980) • Generation Next or Millennials (1981-1999)